{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T13:54:40Z","timestamp":1791986080789,"version":"4.4.0"},"reference-count":31,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T00:00:00Z","timestamp":1734998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Perforations represent rare but serious complications in ERCP. Although several therapeutic algorithms have been proposed to properly address these potentially life-threatening events, there is still no clear consensus on their management. We conducted a single-center retrospective study in order to assess the incidence of ERCP-related perforations and their management, as well as clinical outcomes. Methods: The hospital\u2019s electronic database was searched in order to identify all the patients who developed ERCP-related perforations in the period 1 October 2018\u201330 June 2023. Perforations were classified according to the Stapfer classification. Conservative management included frequent abdominal examinations, the monitoring of vital signs, white blood cell count, complete bowel rest, nasogastric tube placement, and the administration of intravenous fluids and antibiotics. Endoscopic management included biliary stent placement and\/or closing observed defects with clips. Results: We recorded eight (1.29%) cases of ERCP-related perforations out of the 619 procedures conducted. We observed six (75%) Stapfer type II and two (25%) type IV perforations. In all but one patient (87.5%), the indication for ERCP was bile duct stones. Seven patients (87.5%) were subjected to sphincterotomy (87.5%) and three (37.5%) to \u201cpre-cuts\u201d. All but one patient was treated conservatively (87.5%), with two of them\u2014in which type II perforations were recognized intraprocedurally\u2014also receiving endoscopic treatment with stent placement. On the day of ERCP, one patient with a type II perforation was operated on; suturing of the duodenum followed by duodenal exclusion was applied. Management was successful in all the patients, with a mean hospitalization time of 16.6 \u00b1 4.78 days. Conclusions: Conservative and endoscopic management appear to be associated with good outcomes in Stapfer type II perforations. Nevertheless, an individual multidisciplinary approach involving endoscopists and a hepatobiliary surgeon is essential in order to properly guide the treatment.<\/jats:p>","DOI":"10.3390\/jcm14010001","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T02:50:56Z","timestamp":1735008656000},"page":"1","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Management of ERCP-Related Perforations: A Single-Center Experience"],"prefix":"10.3390","volume":"14","author":[{"given":"Nemanja","family":"Plecic","sequence":"first","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Malenkovic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksa","family":"Begovic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Pavlovic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-6327","authenticated-orcid":false,"given":"Milutin","family":"Bulajic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Department of Digestive Endoscopy, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Bulajic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladimir","family":"\u0110ukic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miljan","family":"Milanovic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Predrag","family":"Savic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikola","family":"Panic","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Department, University Clinic \u201cDr Dragisa Misovic-Dedinje\u201d, 11000 Belgrade, Serbia"},{"name":"Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4103\/aer.AER_9_19","article-title":"A Comparison of Stress Response between Insertion of Gastro-Laryngeal Tube and Endotracheal Intubation in Patients Undergoing Upper Gastrointestinal Endoscopic Procedures for Endoscopic Retrograde Cholangiopancreatography","volume":"13","author":"Davis","year":"2019","journal-title":"Anesth. Essays Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s10140-019-01689-w","article-title":"Accuracy and timeliness of an abbreviated emergency department MRCP protocol for choledocholithiasis","volume":"26","author":"Tso","year":"2019","journal-title":"Emerg. Radiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1177\/2050640614560784","article-title":"ERCP-related perforations in the new millennium: A large tertiary referral center 10-year experience","volume":"3","author":"Kodali","year":"2015","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_4","first-page":"73","article-title":"Complications related toendoscopic retrograde cholangiopancreatography: A comprehensiveclinical review","volume":"18","author":"Silviera","year":"2009","journal-title":"J. Gastrointestin. Liver Dis."},{"key":"ref_5","first-page":"403","article-title":"Duodenal Perforations After Endoscopic Retrograde cholangiopancreatography: Spanish Association of Surgeons","volume":"93","author":"Marrero","year":"2015","journal-title":"Cirug\u00eda Espa\u00f1ola Engl. Ed."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.tgie.2012.06.001","article-title":"Complication s of endoscopic retrograde cholangiopancreatography","volume":"14","author":"Freeman","year":"2012","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1503\/cjs.027110","article-title":"Management of ERCP-related small bowel perforations: The pivotal role of physical investigation","volume":"55","author":"Dubecz","year":"2012","journal-title":"Can. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1007\/s11605-011-1723-3","article-title":"A tailored approach to themanagement of perforations following endoscopic retrograde cholangiopancreatographyand sphincterotomy","volume":"15","author":"Polydorou","year":"2011","journal-title":"J. Gastrointest. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/00000658-200008000-00007","article-title":"Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy","volume":"232","author":"Stapfer","year":"2000","journal-title":"Ann. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S1479-666X(08)80094-7","article-title":"Management of endoscopic retrogradecholangiopancreatography-related perforation","volume":"6","author":"Lai","year":"2008","journal-title":"Surgeon"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1177\/000313480907500605","article-title":"Endoscopic retrograde cholangiopancreatographygut perforations: When to wait! When to operate!","volume":"75","author":"Morgan","year":"2009","journal-title":"Am. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1001\/archsurg.142.5.448","article-title":"Pancreaticobiliary andduodenal perforations after periampullary endoscopic procedures: Diagnosis and management","volume":"142","author":"Fatima","year":"2007","journal-title":"Arch. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1051597","DOI":"10.1155\/2016\/1051597","article-title":"Endoscopic Closure for EUS and ERCP Related Duodenal Perforation by Endoclips","volume":"2016","author":"Liu","year":"2016","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e31868","DOI":"10.1097\/MD.0000000000031868","article-title":"Endoscopic treatment for duodenal perforation due to biliary stent dislocation: A case report and brief review of the literature","volume":"101","author":"Fujii","year":"2022","journal-title":"Medicine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.4253\/wjge.v7.i14.1135","article-title":"Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management","volume":"7","author":"Vezakis","year":"2015","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_16","first-page":"379","article-title":"A systematic review of the management and outcome of ERCP related duodenal perforations using a standardized classification system","volume":"15","author":"Cirocchi","year":"2017","journal-title":"Surgery"},{"key":"ref_17","first-page":"746","article-title":"Comparison of early and delayed diagnosis of mortality in ERCP perforations: A high-volume patient experience","volume":"26","author":"Borazan","year":"2020","journal-title":"Turk. J. Trauma Emerg. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0016-5107(98)70121-X","article-title":"Major early complications from diagnostic and therapeutic ERCP: A prospective multicenter study","volume":"48","author":"Loperfido","year":"1998","journal-title":"Gastrointest. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1055\/s-2002-23650","article-title":"ERCP-related perforations: Risk factors and management","volume":"34","author":"Enns","year":"2002","journal-title":"Endoscopy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1055\/a-1222-3191","article-title":"Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement\u2014Update 2020","volume":"52","author":"Paspatis","year":"2020","journal-title":"Endoscopy"},{"key":"ref_21","first-page":"237","article-title":"Decision for surgical management of perforation following endoscopic sphincterotomy","volume":"57","author":"Bell","year":"1991","journal-title":"Proc. Soc. Am. Gastrointest. Endosc. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/S0016-5107(91)70740-2","article-title":"Endoscopic sphincterotomy complications and their management: An attempt at consensus","volume":"37","author":"Cotton","year":"1991","journal-title":"Gastrointest. Endosc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1046\/j.1445-2197.2003.t01-15-.x","article-title":"Surgical management of endoscopic retrograde cholangiopancreatography-related perforations","volume":"73","author":"Preetha","year":"2003","journal-title":"ANZ J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1055\/s-0033-1344230","article-title":"Clinical course and proposed treatment strategy for ERCP-related duodenal perforation: A multicenter analysis","volume":"45","author":"Jin","year":"2013","journal-title":"Endoscopy"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1007\/s00464-012-2702-9","article-title":"Management of duodeno-pancreato-biliary perforations after ERCP: Outcomes from an Italian tertiary referral center","volume":"27","author":"Alfieri","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.14740\/gr1007w","article-title":"Non-Operative Management of Type 2 ERCP-Related Retroperitoneal Duodenal Perforations: A 9-Year Experience from a Single Center","volume":"11","author":"Theopistos","year":"2018","journal-title":"Gastroenterol. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/j.gie.2015.09.039","article-title":"Algorithm for the management of ERCP-related perforations","volume":"83","author":"Kumbhari","year":"2016","journal-title":"Gastrointest. Endosc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2305","DOI":"10.3748\/wjg.v16.i18.2305","article-title":"Primary endoscopic approximation suture under cap-assisted endoscopy of an ERCP-induced duodenal perforation","volume":"16","author":"Lee","year":"2010","journal-title":"World J. Gastroenterol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.vgie.2018.02.003","article-title":"A novel, duodenoscope-friendly endoscopic clip for treating massive upper-GI bleeding secondary to a Dieulafoy lesion","volume":"3","author":"Aranez","year":"2018","journal-title":"VideoGIE"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E424","DOI":"10.1055\/s-0032-1325738","article-title":"Endoscopic closure of an iatrogenic duodenal perforation: A novel technique using endoclips, endoloop, and fibrin glue","volume":"44","author":"Samarasena","year":"2012","journal-title":"Endoscopy"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.1097\/SLE.0000000000000240","article-title":"Can a fully covered self-expandable metallic stent be used temporarily for the management of duodenal retroperitoneal perforation during ercp as a part of conservative therapy?","volume":"26","author":"Odemis","year":"2016","journal-title":"Surg. Laparosc. Endosc. Percutaneous Tech."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/1\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:58:52Z","timestamp":1760115532000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/1\/1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,24]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["jcm14010001"],"URL":"https:\/\/doi.org\/10.3390\/jcm14010001","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,24]]}}}